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Published on: May 9, 2013
Left-side preference in carotid endarterectomies
B G Maxwell1, J G Maxwell, C C Brinker
1Department of Surgery, Coastal Area Health Education Center, Wilmington 28402-9025, USA.
Insights
Left carotid endarterectomies (CEs) are performed more often than right CEs, though outcomes are similar. Surgeons may consider patient dominance when deciding which side to operate on.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease
- Surgical Outcomes
Background:
- Carotid atheromatous disease incidence is presumed equal between right and left carotid arteries.
- Previous studies have not reported differences in the frequency of right versus left carotid endarterectomies (CEs).
Purpose of the Study:
- To investigate if right and left CEs are performed with equal frequency.
- To determine if there are outcome differences between left and right CEs.
- To explore surgeon practices regarding side selection for CE.
Main Methods:
- Retrospective chart review of 2305 CEs performed between 1979 and 1998.
- Data collection included side of procedure, demographics, comorbidities, procedural details, hospital stay, and complications.
- Surgeon survey on practice patterns and consideration of side-related factors.
Main Results:
- Left CEs (52%) were performed significantly more often than right CEs (48%) (P = 0.014).
- No significant differences were observed in demographics, comorbidities, preoperative symptoms, length of stay, or postoperative morbidity/mortality between left and right CEs.
- A majority of surveyed surgeons consider the relationship between the side of carotid disease and the patient's dominant side.
Conclusions:
- A statistically significant disparity exists in the frequency of left versus right carotid endarterectomies.
- This difference may be influenced by surgeons' consideration of the side supplying the dominant hemisphere.
- Further prospective studies are needed to explore the impact of CE side and patient dominance on outcomes.
Abstract:
Although the incidence of carotid atheromatous disease is presumably equal between the right and left carotid arteries, right and left carotid endarterectomies (CEs) may not be performed with equal frequency on the two sides. This study sought to examine whether right and left CEs are performed with equal frequency and whether there are any differences in outcome between these groups. Detailed chart review was performed on all CEs performed from 1979 through 1998 at our institution, and those lacking side data were excluded. Data were collected on the side of the procedure, demographics, comorbid conditions, details of the procedure, hospital stay, and major complications. The surgeons performing CE were surveyed about their practice of considering side factors. CE was performed on the left in 1190 (52%) of 2305 procedures; 1115 (48%) of the procedures were right CEs. This difference is statistically significant (P = 0.014). No significant differences in demographics, comorbidity, presence of symptoms before surgery, length of stay, or postoperative morbidity or mortality between the left and right groups were found. A majority of the surgeons surveyed indicated they do consider the relationship of side of the carotid disease to the patient's dominant side. The significant difference in the performance of left CE more often than right has not been previously reported. This may reflect willingness by surgeons to intervene more frequently in carotid disease on the side supplying the dominant hemisphere. A prospective CE outcome study that identifies the side of CE and the patient's dominant side is needed for further exploration of this issue.
